Colo. health care provider tames pain with non-pill treat­ments

The Denver Post - - FRONT PAGE - By Jesse Paul

lafayette» Over the roughly two decades Lynell Reed was pre­scribed opi­oids in in­creas­ing po­tency to cope with pain from an in­jury she suf­fered in a car crash, the elec­tri­cal en­gi­neer and sales executive tried sev­eral times to come off the pow­er­ful drugs.

But dur­ing each at­tempt to quit her med­i­ca­tions — rang­ing from mor­phine to methadone to fen­tanyl, which is con­sid­ered 50 times more pow­er­ful than heroin — Reed ag­o­nized for months from the ef­fects of with­drawal.

Then her health care provider rec­om­mended she join a new Kaiser Per­ma­nente clinic aimed at help­ing pa­tients bet­ter man­age their pain and come off po­tent drugs. At 64, she has been opi­oid-free since June.

“I feel like a dif­fer­ent per­son,” Reed said. “The clinic to­tally turned my life around.”

Since Jan­uary 2015, Kaiser has been run­ning what it calls a one-of-a-kind in­te­grated pain-ser­vice class aimed at help­ing its high­risk opi­oid pa­tients bet­ter man­age their pain through al­ter­na­tive treat­ments and un­der­stand the risks of the drugs. The idea is to show pa­tients they don’t nec­es­sar­ily need a pain pill to man­age their pain.

With Colorado and the na­tion in the grips of a pre­scrip­tion painkiller epi­demic — which has been blamed for a resur­gence of heroin and sky­rock­et­ing over­dose deaths — those run­ning the pro­gram hope it can be a way to stem the ris­ing tide and pre­vent over­doses and ad­dic­tion.

Opi­oid-linked deaths in Colorado have risen sharply over the past 17 years, from 73 in 1999 to 329 in 2015, ac­cord­ing to Colorado Department of Pub­lic Health and En­vi­ron­ment data. The state also ranks among the high­est in pre­scrip­tion drug abuse.

So far, more than 200 pa­tients have en­rolled in the eight-week ini­tia­tive, which is staffed by 15 health care providers — rang­ing from psy­chol­o­gists to phar­macy spe­cial­ists — and based out of Kaiser’s Rock Creek cam­pus in Lafayette.

The class teaches par­tic­i­pants about op­tions out­side of a pill to man­age their pain, from deep-breath­ing to changes in their diet. The ses­sions also teach how opi­oids re­act with other med­i­ca­tions. At a re­cent ses­sion, about a dozen peo­ple lis­tened to a physi­cian talk about the ben­e­fits of acupunc­ture with a few of them get­ting pricked to see how it works.

“We’ve be­come aware that there is a na­tional epi­demic of opi­oid pre­scrib­ing and it not be­ing as ef­fec­tive as we thought it was go­ing to be,” said Amanda Bye, a clin­i­cal psy­chol­o­gist who helps run the ser­vice. “The in­dus­try thought that pre­scrib­ing opi­oids was go­ing to be rel­a­tively safe given that we were pre­scrib­ing it for can­cer pa­tients who were at the end of their lives. Decades later, we know dif­fer­ent things now. We know that long-term use has a higher risk than we thought it was go­ing to have with a lower ben­e­fit.”

Kaiser has been very ag­gres­sive in ad­dress­ing opi­oid pre­scrib­ing, launch­ing a re­view of all of its opi­oid pa­tients and com­mit­ting to re­duc­ing the vol­ume of the drugs be­ing di­verted into com­mu­ni­ties.

One of the ideas stressed in the clinic is that opi­oids are not painkillers. They are pain man­agers.

“Best care is not just med­i­ca­tion,” Bye said. “We know that us­ing opi­oids alone aren’t that ef­fec­tive for man­ag­ing chronic pain. Opi­oids alone are about 30 per­cent ef­fec­tive, at best, for help­ing man­age chronic pain. We know that cog­ni­tive be­hav­ior skills — such as deep breath­ing, mind­ful­ness, re­lax­ation — are about 50 to 60 per­cent ef­fec­tive.”

Those re­ferred to the in­te­grated pain ser­vice are con­sid­ered high-risk be­cause of fac­tors in­clud­ing the high dose of opi­oids they are be­ing pre­scribed or a his­tory of drug abuse or mis­use.

Three other satel­lite pro­grams in the Den­ver-Boul­der area of­fer the ser­vice to pa­tients with lower risk for neg­a­tive out­comes.

“I think to get a pro­gram like this is pretty spe­cial,” said Will Ger­sch, a clin­i­cal phar­macy spe­cial­ist in pain man­age­ment who works in the ser­vice. “Pa­tients that don’t take ad­van­tage of this re­source, they don’t have the same knowl­edge of the risks.”

Ger­sch said some pa­tients are some­times re­luc­tant to aban­don or re­duce their use of opi­oids out of fears of with­drawal and pain flares.

“They feel like that med­i­ca­tion is the only thing tak­ing their pain away,” Ger­sch said. “So when you’re tak­ing that one thing away they feel like will man­age their pain, that’s a lit­tle scary. But giv­ing them other op­tions, that re­duces a lot of that fear.”

Robert Valuck, direc­tor of the Colorado Con­sor­tium for Pre­scrip­tion Drug Abuse Pre­ven­tion, says he doesn’t know of an­other pro­gram in Colorado quite like Kaiser’s. Some sim­i­lar ini­tia­tives will have pieces of the in­te­grated pain ser­vice — such as be­hav­ioral coun­sel­ing or group ses­sions — but not all to­gether.

“I think it has that po­ten­tial,” said Valuck, who teaches drug safety at the Uni­ver­sity of Colorado’s An­schutz Med­i­cal Cam­pus. “The most stud­ied ex­am­ples of this kind of in­te­grated pain man­age­ment date back to the 1970s. The hard thing is how do you scale that thing. If there are 500,000 peo­ple a month in Colorado get­ting an opi­oid pre­scrip­tion, how can you get them all in that class?”

Valuck says most peo­ple who be­come opi­oid abusers are not chronic pain pa­tients. About 70 per­cent started with some­thing they got from some­one else’s medicine cab­i­net. The hope, he says, with pro­grams such as Kaiser’s is that the ed­u­ca­tion el­e­ments will trickle out.

“So of­ten, (when) in­di­vid­u­als get a pre­scrip­tion, they don’t nec­es­sar­ily ask the right ques­tions rel­a­tive to how to take it with other med­i­ca­tions,” said Suzi Stolte, co-chair of the JP Pre­scrip­tion Drug Aware­ness Foun­da­tion.

Stolte’s daugh­ter, Heidi, died of mixed drug tox­i­c­ity in 2011 after she was pre­scribed opi­oids for a back in­jury.

“I think peo­ple so of­ten think, ‘Oh, I can take this painkiller and go from a nine or a 10 on the pain scale to a zero or 1,’” Stolte said. “That’s not what hap­pens. You don’t have that kind of swing.”

He­len H. Richard­son, The Den­ver Post

Lynell Reed walks along a lake near her home in Boul­der. Reed, who has lived with chronic pain, bat­tled ad­dic­tion to opi­oids un­til she found a pro­gram that helped her deal with her pain in dif­fer­ent ways.

He­len H. Richard­son, The Den­ver Post

Through Kaiser Per­ma­nente, Lynell Reed and other pa­tients who are fight­ing ad­dic­tion to opi­oids can en­roll in an eight-week, pain­man­age­ment course.

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